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18-Year-Old with Sore Throat
This case features an 18-year-old presenting with sore throat, ultimately diagnosed with Lemierre syndrome (postpharyngitis venous thrombosis).
Imaging overview:
Axial contrast-enhanced CT demonstrates an enlarged right palatine tonsil with surrounding edema and an associated peritonsillar abscess. Coronal contrast-enhanced CT shows a long-segment filling defect within the right internal jugular vein consistent with thrombosis. Pulmonary imaging to evaluate for septic emboli is an essential component of the workup, though not shown in this case.
Clinical insight:
Lemierre syndrome is a rare but life-threatening condition defined by the triad of recent pharyngitis, ipsilateral internal jugular vein thrombosis, and septic emboli, most commonly to the lungs. It is classically caused by Fusobacterium necrophorum, an anaerobic gram-negative bacillus. Recognition of IJV thrombosis in the setting of oropharyngeal infection should prompt urgent evaluation of the lungs for cavitary pulmonary nodules reflecting septic emboli. Careful evaluation of both the vessels and the lungs is paramount in any head and neck infection, particularly in young patients with severe or worsening pharyngitis, as early diagnosis significantly impacts management and outcome.
Case courtesy of Miguel Ibarra, MD, and Benjamin Gray, MD, Indiana University School of Medicine.